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HEARNAP — Part 36
Page 592
592 / 734
mutes:
je IX _wetene__ 552” wesant 103 ths. of tyes Ta’ ne Hair blo d
seal iesoNLAG wie
st serious Ilinesses, Operations or Accidents:
|
As a child?.
As an adult?_
| Beer a Reason AY
tver suffer from ee : me Ber oe
Tuberculosis... ©
‘Beck Problem_____.
Eye Problen_____.
Rheumatism.
Skin Allergy__.——
ae yt at os Drug Allergy ————
Ulcers oS ee Bleed Pressure Lo |
| Foot Problem Epilepsy _____-___—=
, Diabetes > Mervousnes es
; Wernia Heart Trouble.
Varicose Veins_____ Asthma
“Yo what extent do you suffer from colds:
Do you regularly take
i
\Wamily health: CG ADY
Blood Type if known:
Iie Yes. to ap above, please explain = also indicate Limitations e if any:
oe
| Draft Classification: . _ ED Ta a EEG Trey ite Je
tee Te 8 ne Lape apepepe gi emane ae gee
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